It seems as though measuring the social aspect of health is easier than measure mental or emotional health - we could look at the number of friends someone has, or the number of times per week that a person hangs out with someone other than family for more than 30 minutes. If we were to measure mental and emotional states, we'd first have to develop some kind of scale that's valid and accepted. For instance when I worked at the Cedars-Sinai medical center, I'd always witness doctors asking patients what their pain level is according to the "pain scale" - a chart of facial expressions depicting what someone might look like when he/she is experiencing various levels of pain. We might have to develop some kind of tool analogous to the pain scale to measure mental and emotional health.
I agree with Dmitry that a scale should we developed that would be valid and accepted. The scale must also be simple to used and both the patient and the health professional can understand. I have seen similar scales used by occupational therapists when they ask their patients on how they feel about doing certain tasks. I think that nurses and doctors already have a lot on their table and adding another item would not help. I think a designated person should be trained to survey the patients and to analyzed the results. This would create more jobs and each individual can focus on their jobs to make the patient better by working together.
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ReplyDeleteI agree that a standardized scale for happiness and measuring "social health" could be a useful tool and a start to addressing the refocusing of health care on the maximization of health. However, I believe that the larger issue to note is how public health officials and medical providers would help patients achieve their highest health potential. I think that physicians should refer their patients to community centers, sports leagues, and other sorts of social outlets when necessary just as they might refer their patient to a psychologist or for an MRI. At the same time, this third era would also require a greater effort on the part of public health to redesign health promotion and education in such a way that the public is actually motivated to engage in healthful activities not just to achieve base levels of health, but to enhance their quality and extent of life.
ReplyDeleteI also agree that maximum health should be the ideal for all healthcare, however it has its problems when dealing with different individuals. Each individual has unique susceptibilities and strengths. How can doctors seek to maximize health without know what patients are susceptible to. In order to truly maximize health, I would think you would have to analyze the genes of the patient and see what potential diseases he/she will most likely have and carry out a treatment plan that is customized to that.
ReplyDeleteI agree that designing scales to measure emotional ad social health is a possible measure focusing on maximizing our potential for living. However, public officials should also work on building community centers for leisure activities or social networking when people score low in these emotinal or social scales. Also, educating people healthy activities through media or various campaigns is also a good way to encourage public to live healthier.
ReplyDeleteI also agree that having physicians assess the social and emotional aspects of health might be counterproductive as this extra task might overwhelm them. I think we also have to consider the challenge of not just measuring these aspects of health, but also what can be done to help enhance positive social networks for those who lack them. Like it was previously mentioned, people who score low on either emotional or social scales can be referred to social activities and services near their area or health workers can receive specialized training to conduct workshops/activities to help enhance a patient’s social skills and relationships. There also needs to be a system that follows up with the patient to certify that the social services they received did indeed improve their social and emotional well being. This could be achieved through a follow-up survey or interview with trained personnel.
ReplyDeleteI believe that it would be helpful to have doctors and nurses assess emotional, social, and mental well being, but I do not believe that it would be feasible. I feel as if doctors already have a lot on their plate and with the shortage of physicians, the focus should still be on healing physical and treating mroe severe mental ailments. I think the assessment of emotional, mental, and social health should be done outside of the doctors office. For example, teachers and counselors in schools should oversee the emotional and social health of students recommending more severe issues to an outside party. There should also be workshops or services for people with social issues to work on their skill sets.
ReplyDeleteFrom my experiences of working in the health care setting, health care practitioners already refer patients to social workers or psychiatrists if they show symptoms of psychological or social distress. At the same time a standard tool for assessment couldn't hurt. However, I agree with Jennie that the larger issue is motivating individuals to maximize their health potential. To strive to be healthier even in the absence of disease. To continue to learn and change one's behaviors to increase one's level of health and happiness. I also believe that this role falls primarily in the hands of public health workers. Physicians and nurses appear to already be swamped with disease and injury cases. It is important that physicians and nurses keep an eye out for disease and help individuals who are sick or injured, whereas public health officials have the opportunity to reach the masses and spread health information and encouragement to maximize one's living potential.
ReplyDeleteWhile I think measuring these aspects of health is a great idea, I believe other work must be done beforehand. This other work I am talking about is teaching people how and why emotional, mental, spiritual, etc. health will enhance one's wells being and improve the quality of one's life. I feel like our culture stresses the importance of physical health and somewhat neglects the value and strength of less measurable health.
ReplyDeleteEmily brings up a really good point -- mental and emotional health is often given short shrift within the larger idea of health (lasting stigmas don't help!). Doctors actually asking about happiness, social well-being, etc may eventually increase the "legitimacy" of less measurable health factors, but efforts at increasing awareness of the importance of mental, social and emotional health are also going to have to come from elsewhere to really drive the ideas home. Messages about these less measurable health factors possibly need to be worked into mass media and other outlets outside of the doctor's office.
ReplyDeleteEveryone has brought up such interesting points, I agree that there needs to be a scale on which to measure these "other healths" we are referring to. I think by allocating time for a nurse or a doctor to ask the patient about their mental, social or emotional health will help prevent a lot of problems further down the road and give patients a better handle on how to reach their highest health potential. Tami and Jennie bring up good points though that we cannot leave it up to just the nurses and doctors in the hospitals, we as public health individuals need to come along side them, guide them and be willing to redesign the hospital lay out so that we can maximize people's time when something is wrong with them and maximize on their health so they don't have to keep revisiting the doctor. Perhaps also if we looked into their mental, social and emotional health more frequently we would find less patients coming into the hospitals.
ReplyDeleteMany valid points have been brought up by my peers. Those that have or currently work in hospitals have stated the existing stress placed on assisting patients already. It would be more practical and beneficial for trained individuals from the public health industry to intervene and survey individuals, while noting their day to day schedule and if there are correlations between levels of happiness and specific activities. This is not the responsibility of doctors and nurses to undertake but should be measured during hospital visits because a patient's social health may be intertwined with their physical health.
ReplyDeleteI do think it is important to measure emotional, social, and mental well being, as having these three aspects of health in check will make work easier for doctors in the long run. Those who have emotional and mental problems, and experience high volumes of stress are at an increased risk of disease. Routinely measuring and providing help for those who have emotional and mental problems should reduce the work burden for doctors in the long run. However, I do agree with the former comments that doctors and nurses already have limited time with their patients and are not currently in the best place to measure emotional, social and mental wellness.
ReplyDeleteI think it is important to work with different aspects of society to measure mental, social, and emotional wellness. I agree with Dimitry and Marisa, in that valid and reliable scales should be developed to measure these three aspects of mental health. I also agree with Suzanne, as schools routinely keep vaccination records, I think schools are at a good place to implement these scales perhaps two to three times a year for all students. Those who fall beneath the normal range can be referred to the school counselor or social worker in order to improve mental wellness. Additionally, even though it may be too much for the health care system to always measure mental wellness I think doctors can also be on the look out for signs of mental or emotional distress during annual exams and refer patients accordingly.
I've noticed a lot of comments suggesting that having a doctor take the time to measure, by whatever means, a patient's mental health/stress level/etc. would not be feasible because it would overwhelm the doctor's already frantic schedule. I can understand this logic in an emergency department setting, particularly since it probably wouldn't yield representative results because the patient had to be taken to the emergency room and is surely stressed anyway.
ReplyDeleteHowever, how hard would it be for a general practitioner (or whoever a person's primary care provider is) to incorporate an mental/social health assessment in well visits? It could even be performed by the nurse beforehand with the weight/blood pressure/heart rate measurement. The fact that people afflicted with or susceptible to poor mental/social health may have problems seeking help (like the stigma Beth mentioned) necessitates that health professionals reach out to these individuals instead of waiting for them to seek help.
Properly implemented, these assessments could facilitate conversations during doctor's visits. When I worked in an Anonymous HIV Testing Program before their pre-test interview clients would fill out a "Risk Assessment" that elicited information about their sexual behaviors, stress levels, perception of sexual risk-taking, etc. to determine their emotional state before administering a stressful HIV test. When I interviewed these clients the assessments proved to be valuable resources that informed and directed our conversations.
If a patient was to be given a mental/social health assessment and was found to be at risk, I think Jennie's idea of referring them to social organizations like community centers would be very beneficial. To take it a step further, for specific conditions like depression/social anxiety disorder/etc. the doctor can help the patient tap into internet support groups and online forums that offer tips for coping with their disorder and resource networks. Given the vast amount of information and people on the internet, the "third era" will have to rely on technology to "maximize one's potential for living."
I like Nick's idea to have this assessment be done during a primary care visit. Emergency Department visits should be for an emergency and this department is often so busy (I think the wait at county is between 36-48 hours). Imagine if this social/emotional assessment was added for every emergency patient, the wait would increase.
ReplyDeleteThe primary care physician should be seeing their patient yearly or more for routine exams. The social/emotional assessment should be added there to truly expand our wellness to not only include the definition of "free of disease", but also assess to make sure that other contributing factors to disease are in check (i.e. emotional stability, stress levels, etc.) All too often these things are overlooked until faced with a major medical issue such as a psychiatric breakdown or a heart attack.
In regards to measuring mental and social wellness, I believe that during primary care visits a medical assistant can take care of those measurements and therefore report any significant findings to the physician. If there are significant findings, he/she can discuss that w/ the patient along w/ his emphasis on optimizing the patient's health. I agree that physical exams need to be more comprehensive and perhaps physicians can extend their appointments to around half an hour rather than a 15 minute check up so that they have more time to discuss the goals they want to see their patients strive for. A little bit more emphasis and time w/ each patient can lead a long way towards avoiding trips to the emergency rooms and clogging resources even more.
ReplyDeleteI also feel that there has to be a change in the schools programs as well. Physical education classes need to be improved starting from pre-school and all the way until 12th grade. There needs to be more emphasis on many various cardio style workouts versus playing just sports or running a mile to meet standards.
Mental health wise, I am not sure if there can be a true measurement of happiness but I do believe that friendships/social interaction can definitely play a major role in the measurement. This is where school counselors have to step in and make it a point not to just discuss future classes, tests , or college applications but also get a genuine feel for each one of their students perhaps a mandatory 1-2 times a semester or quarter depending on the school. Monitoring kids early on can lead to much more efficient systems of health services and definitely more healthier adults. Whether school budgets will allow for this possibility is another issue all together.
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ReplyDeleteSo I wrote a nice, long comment but then when I submitted it, it didn't work. So, hopefully I have the patience to write it again.
ReplyDeleteI almost completely disagree with the notion that a scale has to be made to help determine the emotional well-being of patients. As we all know, such a scale is used to assess the amount of pain patients are in. However, do we really know how accurate/useful it is? From experience working in the emergency department for a couple years, this kind of scale is mostly used during triage to quickly assess the severity of a situation, and even so, it is not used very often. Most doctors and nurses that I worked with relied more upon other cues like body language to determine how much pain a person was in. Also, I learned that people have entirely different thresholds for pain (like, say, a middle-aged woman who's gone through several pregnancies or a person with some chronic debilitating condition versus an adolescent boy who's almost always been healthy) and that people will lie to get faster service (sort of like the people that say they have chest pain because they know they'll get in faster, others will say their pain is a 10 even though they are sitting in the chair able to speak). Thus, a scale for evaluating emotional well-being, or happiness, would only be minimally useful as it is even more subjective than physical well-being. Although, I do say this while thinking about it in an emergency setting. In primary care circumstances, I do think it is very beneficial to evaluate mental and emotional well-being, but this is done more effectively through a conversation with a trained psych professional than a generically-trained physician. Experience dealing with mental and emotional problems is probably the best way to catch these problems in others. Maybe there can be a case made that physicians should be trained better to deal with these problems to more fully serve the population in this "third era."